What you need to know about insurance marketplace

What you need to know about insurance marketplace

Obamacare health coverage enrollment starts Tuesday.

Here are some of the things you will need to know if you plan to apply for coverage through the state marketplace, called Get Covered Illinois, apply for tax subsidies to help pay for coverage or check out coverage for lowest-income uninsured state residents under the state Medicaid program:

Is marketplace for you?

The marketplace is largely intended for the uninsured and small businesses to shop for health plans. Most of the uninsured in Illinois fall into the following categories, according to state:

— Young adults.

— Employees of businesses not offering coverage.

— People who have lost coverage for any reason.

— People with pre-existing health conditions who have been denied coverage.

— And people who can't afford coverage.

People in employer health plans meeting certain conditions or who are enrolled in Medicare, Medicaid, the Children's Health Insurance Program, All Kids, TRICARE, Veterans Health Care Program or a COBRA plan are considered covered.

A separate area of the marketplace, called SHOP, is for small business owners with 50 or fewer full-time-equivalent employees to go shopping for small group insurance plans.

Where to start?


This is the official state marketplace website. Here, you will be able to find and compare health plans being offered in your area, apply for coverage and apply for subsidies to reduce your premium payments.

What should you have ready?

Full names and dates of birth for all family members needing insurance, information about each family member's income and their social security numbers.

What if you want to talk to a human being?

Trained community assistors to help with enrollment are based at local public health departments and districts and a complete list of where to find in-person help in your community will be on the Get Covered Illinois website.

Help is also available on the phone through this federal help line: 800-318-2596.

How do you know if you need a marketplace health plan or Medicaid coverage?

No need to worry about it. You'll be asked some initial screening questions on the marketplace website and, based on your answers, directed either to the marketplace insurance plans or Medicaid's online application site called ABE.

How long will open enrollment last?

Open enrollment will run through March 31, 2014, but for coverage to begin Jan. 1, enrollment must be done by Dec. 15, 2013.

How much will the plans cost?

Rate information isn't yet available. But expect rates to vary by age, where you live, whether or not you use tobacco and what level of coverage you select.

Plans are categorized in "metal" terms of bronze, silver, gold and platinum that relate to the amount of cost-sharing the policyholder will have. Bronze plans have the lowest premiums and the highest out-of-pocket costs, and platinum plans have the highest premiums and the lowest out-of-pocket costs.

What is the financial assistance?

Tax credits are available on a sliding scale, depending on income and family size. The cut-off for premium help for an individual is an annual income of $45,960, and for a family of four, it's $94,200.

Some people will also qualify for discounts on out-of-pocket costs.

Tax credits are also available for small business owners with fewer than 25 employees to help cover the cost of providing coverage for them.

What happens if you remain uninsured next year?

Under the Affordable Care Act, nearly everyone must have health coverage next year or pay a penalty when filing 2014 taxes.

Penalties will be waived if you were uninsured for less than three months of the year, determined to have a very low income and coverage is considered unaffordable or you earn so little you don't have to file a tax return.

Some other exceptions to the requirement: You're a member of a federally recognized Indian tribe, are a member of a religious group that objects to health insurance.

What are the penalties?

For 2014, it's 1 percent of your annual income or $95 per person for the year, whichever is higher. For uninsured children next year, the fee is $47.50 a child, with the maximum family penalty $285.

Penalties increase by the year, with the 2016 fine running 2.5 percent of your income or $695 a person, whichever is higher.

Sources: Get Covered Illinois press materials and http://www.healthcare.gov

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